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1-1uI C-%j vv vc.:rty onv wnsulung tngrs * he [W-459-1584 p.2 <br /> DATE RECENED <br /> SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov, hd <br /> -�^ �1 EZ3 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> � � <br /> APPLICANT: .fen&TlL It tAulf.4 i BUSINESS/AGENCY: CI�r;�JJ P_��c r�F,r�•/�;j��Z-n� <br /> ADDRESS: yg,_ S. /�.c.yr `J'f /tJ�i/- 64 <br /> PHONE(1): fib? -9/S-g —x/57b PHONE(2): - - - FACSIMILE(2�10 TENTATIVE*APPOINTMENT DATE: Time: <br /> n (Please allow ten business days from date of application submittal-•Tentat"only-nwst be confirmed) <br /> SV( CHECK BOX TO EXPEDITE REQUEST-$98 (C O ONLY)-REQUEST PROCESSED IN THREE BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE -O�Q$ <br /> Electronic Inforrnation: ❑List❑ ap-Descrtp ion: <br /> FILE ADDRESS EHD USE ONLY <br /> Street a Street Name City ❑Unit 1 <br /> IlAt,'11 YIAI <br /> 2. A ❑Unit 2 <br /> 3. <br /> ----? <br /> 4' I nit3 <br /> 5. <br /> 6. <br /> aE4< <br /> 7. <br /> 8' l7 Unit s <br /> 9. <br /> 10• ( 13Unit 6 <br /> I <br /> Specific Date Range of Information Requested:From to <br /> ,f ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> X�,j�'yDERGROUND TANK[UST)CLEANUP SITE(LOP) C3 HOUSING ABATEMENT ❑SOLID WASTE FACILITY/VEHICLE <br /> J��,QI/.VTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY 0 WASTE TIRE <br /> XrIJIJNDERGROUND TANK(MONITORINWREMOVAL) ❑DOG KENNEL 0 DAIRY <br /> "lo NAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH O WASTEWATER TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPERTRUCK/YARD/CHM TOILETS <br /> 0 TATTOOIBODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> VVELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REIAEIN -MONDAY-FRIDAY 8:00 AMd:00P* - EXCLUDING HOLIDAYS. <br /> 1. list up to ten addresses in the space above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to f209)464-0138 or mail to the above address. Address ranges will <br /> not be accepted-for additional assistance with file addresses,contact the EHD. Applications received after 3:00 pm will <br /> be processed the next business day. <br /> 2. The EHD will notify the applicant If any EHD files exist. An appointment for review will be confirmed approximately ten <br /> days after receipt of application. The files will be held for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 3. A file that is acdvety being worked on by the EHD staff may not be immediately available for review. A new application <br /> may be submitted when the file Is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant <br /> Future file reviews by the same applicant may require a$98.00 deposit prior to review. <br /> EHD USE ONLY <br /> END aaAll lei" T <br /> PUBLIC RECORDS RELEASE APP FORM <br />